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tv   [untitled]    April 12, 2015 4:00am-4:31am PDT

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be reimbursed. >> they'll be educate and it's done by phone. >> uh-huh sometimes phone and sometimes mail. >> interesting. >> all right. please precede i know the next slide was pharmacy reduction. >> to minimize disruption so. >> that feels what i was saying it is all of the medicare ab city people they can move over to the national p p plan and we'll look at the claims and reach out to the doctors we don't have a history of ref claims. >> i'd like to see what the network disruption had a are members having now and what they'll have now even without the full replacement. >> we ran the exclaims there
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and analyzed them 62 percent of claims that run through the system last year would be submitted by the doctors in the network. >> so 38 percent. >> uh-huh having said that we've received the claims from doctors out of network i can get more information for that. >> okay. please precede. >> so if you look at slide 6 pharmacy disruption this feels what i was talking about today in terms of how how risk medications are treated different under the national ppo plan again, we would get more information for you on exactly what that looked like in terms of clinic terms and as i said if you move everyone from the current plan into this national
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ppo plan it would be 9 hundred members plus if you offer this in open enrollment they don't have to move but we don't know who is impacted. >> on this point i say you say you haven't filled the cms your formula for 2006 when will- >> that will be foiled over the summer. >> that would be important this is a business prospective you've got to get an approved by certain dates i'd put a red star besides that one i don't know how long is take for powerful they motive fast tracking track you through the process but knowing again, we're kind of doing this without kind of the
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full detail is from a policy standpoint raises a question. >> of we'll get more information on that, too. >> can i ask the mechanic formula is the same as the other. >> it would be the same formula last year, it is the treatment of high-risk medication. >> but an approval process with the cms. >> surely we do that every year. >> okay. all right. >> do you want to mention that their expected to be rolled out to your part d plan we're starting in 2016 with the medicare advantage plan last sliced we're talking about the advantages of the national p p pox your members are flexibility they can go to in
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network and out of network doctors and enjoy the same plans they've enjoyed significant savings we have relatives in greater health outcomes and we have a number of different programs that are tailored for a senior population that i know has been positively received by the seniors in the national ppo plan. >> i'll again caution we've got this is california and it is california other piece of this is fundamental with anything that is new i'm not singling you out it raises questions with other health care partners we see something that maybe looking intill earth and heaven ring. and the songs for this season what can we expect next year in
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terms of premiums are other assumes you're going to incorporate i know you can't answer that on the spot or at least some consideration that makes assumption you get a portion of the population let's see it is a threshold portion and you must have that number in mind some level of enrollment to make that worthwhile for you to do or not i'll leave that to you to get the number once you do that beyond negotiation in making assumes so on what is subsequent look like is this a one-time thing all this good stuff can happen or good sustainable this is really our interest here we don't want to have members whip assaulted with the result we want to say we've landmarked the details we've
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asked you to provide and tried to take a look ahead and we can all the assumptions and puts and takes what might happen and song at least leaning forward to try to look at what's the next step if we make this discussion. >> absolutely thank you for your feedback and we'll look at that to get assumptions that way you can have more information on the division. >> can you thrum who egg has a national p p plan does any other - >> who is your competition. >> we do i want to get confirmation we talk about that there are two other carries i can get that information too. >> it smells we have this
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referring what is it meant to be and we couldn't do that, of course this year is it a great idea for a national p p but it should be well individual and see what other carries have this is the purpose. >> director dodd we actually consulted whether or not in the change in the provider or funding we made the change you made the change to go take blue shield from being fulfill insured a flex funded this will add a funding mechanism it wouldn't take from that but add for the unite health care to be self-insured or fully insured. >> so we've never had a national ppo this is a new
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animal to me and it smells another carries should have an opportunity to bid on this i'm thinking for the best deal for the members i i don't imagine that will happen this year. >> we looked at it as a fundamental change or self-insured and fully insured the care is managed in a different way but essential the same benefit plan so - >> okay we'll come back to that question i'm sure as we get more of the data you've got a laundry list of things i'd like say providing some response to some of those acquires by the next meeting will very 3r0u67b8d be useful the key amongst the thing is the appendix and the data recommended to that to have a
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clear understanding of what it is actually saying to us. >> i'll be happy to provide that one of the things camp mather rip do you want me to speak about the hearing aids this meeting. >> do it now. >> one the question about hearing aids and our proposal the proposal includes the $0 co-pay up to 25 hundred disallowance every year every 6 months and mined your current plan it is 15 percent of the $2,500 allowance every 36 months we quoted a compatible benefits. >> i couldn't read the side by side comparison. >> i'll get you a larger comparison. >> i do contact about four provides and they all take medicare as primary but not take
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this type of plan that's what i - you know they were the top $15. >> so you reached out perp. >> as a personal therapist and chiropractics and those are the ones who are not in the hmos two. >> usually the same people. >> sure we would explain we'll pay one hundred percent of how medicare pays. >> well, they were a little bit skeptical they generally only take medicare as a primary that's the question and so one of them didn't take usc because the reimbursement was solo. >> thank you for your feedback if you want us to educate them on our products we'll do that
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there's a high degree of success let me know. >> that's okay. i wanted to ask noel a couple of things i was looking at want number of medicare people. >> let's hold are that line of questions any more questions for the representative all right. do you have additional questions. >> all right. >> absolutely i'm just michelle is saying she times me to say this is a medicare advantage. >> thank you all right. so thank you very much for this update and there's questions from her the actuary please stand by there maybe an additional question coming out of that, please. >> right now in the plan the
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actives are pooled are the early retirees. >> yes, ma'am. >> not with the medicare. >> obama. >> in the future the plan would be to take everyone into the m a pd plan you'll have left the actives and the early retirees the most expensive this plan will not go on after that. >> you'll be left with the actives and early retirees correct so those people the rates they have now as we've heard earlier the contributions and rates are expensive there's so few left so if we diswe need to handle the splits the non medicare people we can have contract is with ab and no way to take care of their
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independents on ab or create a program but we have a separate thing to discuss that is not in concert with this what are we're going to do about the early actives and retirees are we're going to bring those numbers down we need to fix that problem that creates another discussion to be honest yes sooner than later it goes away or we make a determined effort to subsidies for all members in the plan did that help. >> it will. >> i mean to confuse you it opens up other considerations. >> yeah. >> you know if this year we have some people that decide to go with that plan i looked at the number of people that only have the option to stay they're not
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in a hmo area there is only 24 thousand but people are president obama to stay in the plan there are not a large number that have to stay and the two city plan. >> the two thousand. >> basically out of area that's absolutely right they live in other places. >> for that 2 thousand that would be a good option we'll not know if their opt for that this or not but the other people like this. >> either stay in the existing city plan or considering the benefits that were offered under the plan it will be better suited for them arrest or we may be in that predict one of the other kaiser is getting so expenditure we basically need to
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have options and consideration of the other vendors offices for retiring. >> on this point i'm going to ask we bring this to a close and see if there is public comment we still have a closed session ahead of us. >> i want to point out that is one of the various reasons blue shield is much hiefrn or higher than 378 a lot of people don't like the claims processing you have to keep track of you've ever been receipts email things in it is a dilemma we'll be offering another option if people can't afford blue shield especially people with dependents. >> we wanted to pay the premium and not deal with the details so this is again, it is a competitive option. >> right audience are you
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concerned about anything else congratulation out of blue shield. >> i'm concerned about an affordable option to our retirees who are in blue shield blue shield is approach unknown affordable. >> i agree that is an affordable choice that's a managed care products people choose a managed products because this is easier one creates composition with blue shield and two it gives our members a choice not so they have to choose kaiser or track their claims. >> the national idea is great but. >> the action item - and keep the detailed. >> the action item we'll instruct hewitt to include those reporter health plan decisions in their june presentation that is we're instructing them
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to do that but we're asking for additional information we've asked united health care for the next meeting they need to be back here toe respond as we're instructing our actually requires the rate cards we'll roanoke county in june. >> we need more information to vote on it. >> i don't think - >> all right. but i'm looking for a motion to either accept this or not and vote it do. >> and i know we've talked about that in the past she said the me to clarify. >> thank you very much for this update and there's questions for the actuary please stand by there maybe an additional question for you coming out of
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that. >> so right now in the plan the actives are pooled with the early retirees and yes, ma'am. >> not the medicare. >> no. >> separate. >> so i'm thinking in the future if the plan b will be next year you take and put everybody into the middle-class ma pd plan so have left the actives and the early retirees the most expensive this plan will not gone after that but in the future. >> we'll be left with the actives and the early retirees correct the rates they have now as we've heard earlier the contribution and rates are expensive they've spiraled to the point so if we decide to keep them to handle the split of the non-medicare people we can
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have contract with ab and no way to take care of their existence only ab or create a program but have a separate thing to discuss that is not in concert what are we're going to do with the ac actives and retirees are we're going to bring that down we need to appendix that that creates another discussion to be honest but, yes sooner than later it goes away or a concerted effort to subsidize the numbers for something relevant for you for all members does that help you. >> workplace well. >> i don't mean to confuse you it opened up other considerations. >> well, if this year we have some people that decide to go with that plan i looked at the numbers of people that have the
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option to stay you know they're not in an area only 2 thousand but anothers are staying here because of the hmo plan. >> the present plan we have with city plan only 2 thousand. >> 2 thousand that's correct. >> they're basically out of area. >> they live in other places yeah. >> so for that 2 thousand that would be a good option because we don't know if they'll opt for this but the other people like this. >> they'll stay in the exist city plan or consider the benefits that are offered in the ma pd plan to be better sued for them or maybe in apreempt it is
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getting so expenditure with blue shield we need other options for the vendor. >> on that point. >> you want me to stop. >> we bring this to the a close and see if there's public comment we still are closed session ahead of us. >> that's one of the very reasons when we say blue shield is 378 blue shield is higher than 378 this year and a lot of people don't like the claims process and handling you have to keep take of your receipts email things in we'll be offering. >> another option. >> if people can't afford blue shield who want to just deal
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with the premium and again, a competitive option. >> right. >> are you concerned about migration out of blue shield. >> i'm concerned about providing american people affordable options to retirees in blue shield blue shield is approaching non-affordable. >> i agree that is an affordable choice it's a managed care product people choose a mechanic product because it's easy if one creates competition with blue shield and two it gives our members a choice not only blue shield but to track their claims and i think did natural is great. >> the action item before us is we'll instruct ann hewitt to
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include those retiree heartache plan and their june presentation that will instructing them to do that but in the interim we're asking for additional information that was asked united health care for the next meeting those representatives or folks need to be here to talk about this more as we're talking about the actuaries talking about the rate card. >> i'll need nor information to vote on that. >> but i'm looking for another motion to either accept this and vote it up and down to instruct the tertiary that's where what the actuary is doing and directing the health plan to come back we've not saying we have a decision.
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>> make a motion this we come back. >> at the june meeting this is additional information. >> i thought we want it at the may meeting. >> no proto provide it at the may meeting. >> not the genuine. >> okay. that's the motion to bring back additional information at the may meeting. >> okay. >> is there a second to that. >> second. >> second all right. >> improperly moved and seconded. >> just for clarification is the motion to bring additional ideas for the may meeting and the rates and stop paying through - >> in the motion was to bring additional information to the
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may meeting. >> including the numbers you can read. >> including the numbers you can read. >> different from what is in the agenda to include the health decisions in june. >> it's different than that. >> we can't make a decision we want more information to read to make a decision all right. >> and then based on the may decision we can stop payment for the june how that timeframe wise for you. >> okay. >> (inaudible). >> would it be feasible to bring a rate card in june or the may meeting. >> i'll be glad to do that all your exerts will not have all the numbers. >> just like what you did for .
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>> - >> yeah. we'll gladly do that, sir. >> at least in the may meet we'll have a rate card in may meeting. >> glad to do that. >> all right. our modifying the motion to include the other data from on hewitt as a primary information along with the other information that u h w is that agreed by i maker of the motion. >> i hope the secretary understand but i'll try to summarize. >> am i okay. >> just go we're instructed the sense of the monoxide we're requesting that the heartache plan provide additional to you
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further the discussion today and instructing on hewitt to have the rate information based on the data before them for the may meet for discussion airbnb action at that time, it's been performing moved and seconded is there further discussion is there discussion by members of the public any public comment. >> public comment excuse me. >> oh, my heaven we've got folks coming. >> this time i mean, i'll wear my police officer hat but i heard the number 38 percent not in network that is a large disruption to me. >> so whatever numbers you put together we need to know exactly how much of a difference this 38
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percent sounds like people know who will do it and who won't. >> thank you for your comment. >> next comment. >> herbert wiener i want to ask for clarification my understanding is with the city health plan if you don't have to have approval in the primary fogs physicians to go to a specialist you can do it directly i'm wondering under the new plan if the same aspect will apply. >> thank you. we'll have it answer at the next meeting as well. >> thank you other questions? or comments excuse me. >> from the public. >> good afternoon. my name is is dave succinctly land a medicare retiree i want to mention i'm an individual that was referred to and the question came up whether the uc c luxury
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u is part of the network that slaying is planning to implement in january 2016. >> all right. thank you. >> thank you very much. >> all right. next public comment? any other public comment on this item? >> this is a worthwhile comment i'm karen wise beyond how you can charge less and get more with this new ppo plan seems like it is, oh and as well i have the city plan and it seems to function like a national ppo i mean, if i'm visiting family in new york i can go to doctor i can still do it how is this different in other words, the money is coming out of something where it the money coming out of
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maybe it is how am i going to pay my doctor, if i have to get a new doctor they're not going to like me if i've offering them appointees and i'd be happen to pay a little bit more i mean i feel grateful i'm not paying that much you guys will have done a great job but a little bit more i don't find that completely you know push me away. >> thank you thank you. >> any other public comment? judy a retired city employee i'm not activity retired i have a house keep issue and possibly a charter legal issue earlier, you mentioned the font has to be a certain any reasonable human being said

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